HIV treatment in the criminal justice system

The advent of HAART has resulted in a dramatic decline in HIV-related morbidity and mortality among those accessing HIV treatment [1]. Fortunately, efforts to simplify regimens and scale up treatment systems have led to individuals being engaged in treatment in numbers and locales that were unimaginable just 10 years ago. Still, some seropositive populations have not benefited equally from advancements in HIV treatment. Studies of HIV-seropositive individuals who use injection drugs (IDU) on HAART confirm that adherent individuals can derive similar benefits as adherent individuals from other risk groups [2]. Nevertheless, coverage of HAART among IDU remains low, not only in areas such as the Russian Federation and other countries of the former Soviet Union and China, where a substantial and increasing proportion of new infections are linked to injection drug use, but also in settings with advanced healthcare systems [3]. Once on HAART, HIVseropositive IDU often achieve lower levels of adherence and are more likely to prematurely discontinue therapy [4,5]. As a result of the individual and, likely, community [6] benefits of attracting and maintaining IDU on HAART, there is an urgent need to identify and remove barriers to access and adherence to HAART among IDU [7].